4. Bibliografy Fast Track Surgery and Systematic review 37 Fast Track Colorectal Surgery 57 Fast-track colorectal surgery. Kehlet H. Lancet. 2008 Mar 8;371(9615):791-3. Implementation of a fast-track perioperative care program: what are the difficulties? Polle SW, Wind J, Fuhring JW, Hofland J, Gouma DJ, Bemelman WA. Dig Surg. 2007;24(6):441-9. Perioperative care in colorectal surgery Current practice patterns and opinions. Roig JV, García-Fadrique A, Redondo C, Villalba FL, Salvador A, García-Armengol J. Colorectal Dis. 2008 Oct 1.
5. Colorectal Dis. Feb 2009. ...” Mechanical bowel preparation is used by the majority (Austria, 91%; Germany, 94%); the vertical incision is the standard method of approach to the abdomen in Austria (79%) and Germany (83%), nasogastric decompression tubes are rarely used, one-third of the questioned surgeons in both countries use intra-abdominal drains . Half of the surgical centres allow the intake of clear fluids on the day of surgery and one-fifth offer solid food on that day”. Conclusions: ...”Although there is an evident benefit of fast-track management, the survey shows that they are not yet widely used as a routine”.
6. MULTI-CENTER STUDY TO INTRODUCE A PROGRAM OF ENHANCED REHABILITATION IN COLORECTAL SURGERY
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18. Hospital Do Mexoeiro. Vigo Hospital Fundación de Calahorra Hospital Clínico Universitario. Zaragoza Hospital Mútua de Terrassa Hospital General Universitario de Valencia Hospital Universitario de Elche Hospital Son Llatzer. Palma de Mallorca Hospital Clínico San Carlos de Madrid Hospital Gregorio Marañón. Madrid Hospital La Paz. Madrid Complejo Hospitalario La Mancha-Centro (A. de San Juan ) Participants
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23. Hospital Do Mexoeiro. Vigo Hospital Fundación de Calahorra Hospital Clínico Universitario. Zaragoza Hospital Mutua de Terrassa. Hospital General Universitario de Valencia Hospital Universitario de Elche Hospital Son Llàtzer. Palma de Mallorca Hospital Clínico San Carlos de Madrid Hospital Gregorio Marañón. Madrid Hospital La Paz. Madrid Complejo Hospitalario La Mancha-Centro (A. de San Juan) 1 st of April 1 st of June Inclusion
24. Retrospective study (data Introduction) Prospective study (prepared for the study) Inclusion June July August September October June July August September October 1 st of April 5 th of November
25. Retrospective study (182 patients) Multi-center study to introduce a program of enhanced rehabilitation in colorectal surgery Preliminary results Average age 69,6 years ± Std. Dev. 13,2 (43 - 89 years). Male 61%. 69% 31% Way of Approach Preliminary results Surgical Technique
26. Complications Post-operative TOTAL: 34,82% % Mean Stay: 12,1 days ± Std. Dev. 13,731 (4-78 days) Preliminary Results Retrospective Study (182 patients)
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28. Degree of compliance 77.1% 63% (*)Implementation of a Fast-Track Perioperative Care Program: What Are the Difficulties? . Sebastiaan W. Polle, Jan Wind, Jan W. Fuhring, Jan Hofland, Dirk J. Gouma, Willem A. Bemelman. Dig Surg 2007;24:441–449 Mean Age 63,4 years ± Std. Dev. 10,2 (38-89 years). Male 60%. Preliminary Results PROSPECTIVE STUDY. n= 84 Pre-operative information 100% 87% Preparation of the intestine 95% 100% Pre-surgery drink the night before 95% 83% Sedation 87% 40% Morning drink 75% 30% Pre-medication 80% 70% Epidural anaesthesia 50% 71% High flow oxygen 70% 67% Oesophageal Doppler 72% Termal blanket 75% 100% Nasal gastric tube 72% Drains 72% Early mobilization 80% 40% Early oral intake ( high calorie drinks ) 56% 13%
31. MEAN Lenght of stay: 5,43 days (3-11 days) Readmission: 4% Preliminary Results PROSPECTIVE STUDY. n= 84
32. Preliminary Results Succes Programm Satisfaction Patient. Complications Mortality Recovery Hospital Stay Re-admission Total Lenght Stay Difficult to Organize and to establish Difficulty to obtain all parameters. We do not have an analasis yet Seems to decrease significantly Similar Similar Seems to be significantly lower <5% 6 days. Seems significantly lower Objetives
